Heart disease is an unwelcome fact of life in the New Orleans area, in part because of our preference for the delicious – and rich – food found in just about everybody’s kitchen. Fortunately, the city’s medical centers are up to the task, offering cutting-edge treatments close to home. Even Hurricane Katrina, which dealt a setback to medical care in most parts of New Orleans, didn’t keep local hospitals from expanding their heart treatment capabilities – good news for those of us who can’t resist beignets, gumbos and bread pudding.
Although some services remain in short supply, particularly psychiatric care and primary care, cardiac care seems to be doing fine, says Paul Sallas, chief executive officer of the Metropolitan Hospital Council of New Orleans. There are about 17 hospitals operating in the metro area, and most have an adequate number of beds for cardiac patients. He suggests one reason could be that cardiology, like orthopedics, remains a profitable line of care for most hospitals, and would be one of the last to be cut back.
East Jefferson General Hospital has returned to, and surpassed, the level of cardiac care it had pre-Katrina, says John Sartori, the hospital’s director of communications. Improvements include a completely revamped cath lab and a new system that allows ambulance personnel to perform heart tests in the field. This information is then sent in real time to emergency room doctors, so that when the patient arrives, the staff is ready to begin treatment. Sartori says East Jefferson meets or exceeds industry standards in this area, and has been recognized for its excellence in cardiac surgery, specifically bypass surgery. The hospital’s cardiac rehabilitation program, the first in Louisiana, recently celebrated its 30th anniversary. The hospital not only serves its community, he says, but also attracts patients from other parishes.
“We’ve expanded our services,” says Dr. Christopher White, chairman of Ochsner Health System’s Department of Cardiology and director of Ochsner’s Heart and Vascular Institute. “We are doing more bypass surgery and more angioplasty [than pre-Katrina].”
As it has rebounded, the city’s population has undergone a shift, White points out. Hospitals remain closed in areas where population is still depressed, such as Chalmette, while those in other parts of town have seen an increase in patients and in doctors to serve them. That is a bonus, White says, because volume correlates well with quality; “Hospitals are stronger now.”
Innovations continue, the cardiologist adds. For example, Ochsner can now perform aortic valve replacements without surgery. The hospital has become one of the top five heart transplant centers in the country, serving patients from all over the state and the region. New devices can stabilize critically ill patients for weeks or months while they wait for suitable hearts to become available.
Not only can local institutions service local patients but also our hospitals remain a major draw for people in other areas. “We have a robust referral practice,” White says.
Post-Katrina, Ochsner hired a specialist in advanced cardiac imaging. The hospital has the only cardiac MR in the region. And patients from as far away as the Arkansas and Texas borders come to Ochsner for its stroke intervention procedures.
Outreach to previously underserved areas of the community is also on the upswing, White says, pointing to the St. Thomas Community Health Center, which offers cardiology services, among others. Ochsner and others have pitched in to help the clinic. Meanwhile, in the absence of Charity Hospital, indigent patients are now being seen at other hospitals, where they receive the same level of care as insured patients.
Mending small hearts
Tulane Medical Center has also been advancing its cardiac care options. The hospital’s new hybrid catheterization and surgical suite is the only such facility in Louisiana, says Dr. Michael Recto, a pediatric interventional cardiologist at Tulane and a professor of pediatric cardiology at Tulane School of Medicine. The suite combines interventional techniques (catheterization) with surgical techniques in the same room, simplifying the placement of stents and other treatments. The suite can treat both adults and children. In the hybrid suite, a surgeon can make a small incision in the patient’s chest, and the cardiologist can use this small opening to gain access through a catheter to the patient’s heart.
The suite makes it easier and quicker to do a palliative treatment for babies born with a single ventricle. In the past, under conventional methods, the mortality rate for this procedure was quite high, Recto says. Now, these infants have a greater chance of surviving this operation, enabling them to have other, less dangerous surgery when they are a little older.
Tulane sees infants, children and young adults from other towns who need sophisticated cardiac care, Recto says. For example, Tulane doctors can completely repair a congenital heart defect known as Tetralogy of Fallot.
Pediatric heart disease affects between four and seven out of every 1,000 children, Recto says. Tulane has opened a satellite clinic at Tulane Lakeside where high-risk fetal echocardiograms can be performed on pregnant women who may be carrying babies at risk of heart problems.
Prevention is a big part of cardiac care at West Jefferson Medical Center, says Dr. Edmund Kerut. “We want the community to be more healthy, and a lot of that is education,” he says. Most of the cardiac patients he sees can be treated at West Jefferson, with occasional referrals to centers like the Mayo Clinic for those with unique problems. The hospital offers all types of services – surgery, heart catheterization, valve replacements – and follows them up with cardiac rehabilitation that includes exercise and programs on heart-healthy menus. The idea is for patients to change their lifestyles, Kerut explains.
An effective tool in Kerut’s arsenal is a CT scan that measures the buildup of calcium in the carotid arteries. When patients show signs of this buildup, physicians can become more aggressive in treating them in an effort to ward off blockages. The test isn’t suited for people who have had a heart attack or who already have diagnosed carotid disease, he says.
Patients should weigh the benefits of the test versus the risk, says Kerut, who has recently written several articles on the topic. Reports of the danger of radiation exposure has caused people to worry about future cancers from all sorts of CT scans, and Kerut says he thinks the controversy will make doctors think more carefully about ordering the tests.
He calls the scans “low-risk, but not no-risk,” and points out that the exposure to radiation from other common diagnostic tests is much higher than that of the calcium scoring scan. The test results can be an eye-opener for patients who aren’t feeling any symptoms of heart problems.
Kerut is especially concerned about the whole-body scans being promoted in magazines. They expose a patient to radiation, the chance of finding anything important is very low, and all kinds of anomalies may be found that turn out to be “red herrings.”
Although cardiac services are in good supply in most places in New Orleans, Kerut acknowledges that St. Bernard Parish continues to lag. His cardiac practice sees patients at the trailer-based St. Bernard Health Center once a week, and he says limited resources are available there.
Frank Folino, administrator at the St. Bernard Health Center, says the parish is about two years away from opening a 40-bed hospital. It is uncertain what level of services the new hospital will offer, he says. He expects the hospital to have a catheterization lab and do mostly diagnostic procedures; open-heart surgery, for example, will not be available.
The Charity question
As other hospitals rebound and grow in the post-Katrina environment, Charity Hospital’s fate remains uncertain. No one knows when, or if, a new “Big Charity” will be built, the Metropolitan Hospital Council’s Sallas says. The closure of the hospital was a big blow to many patients, says Dr. Luke Glancy, a professor of cardiology at LSU School of Medicine. Glancy, who also had a private practice for many years, teaches cardiac fellows, residents and students at the LSU Interim Public Hospital (formerly Hotel Dieu). Right after the storm, he says, doctors had to treat patients without some of the modern facilities they were used to. “That didn’t please me or anybody else,” Glancy says. Things are back to normal now, he says, although it can sometimes be a bit of a struggle for public patients.
Like other physicians, Glancy says patients in New Orleans are fortunate to be able to obtain most types of cardiac care locally. “People want to stay close to home,” he says. Appointments with cardiologists are also readily available, he says, although it can vary depending on where you live. Having to go to other cities for cardiac care can delay treatment, Glancy says, and puts a patient at the mercy of an out-of-town clinic’s schedule.